Look At Me In The Eyes!...ANGLE ANATOMY Put an iStent right here Internal Anatomy Lamina Cribrosa...
50
Look At Me In The Eyes! Anatomy of the Eye Brent Deibert, MD
Transcript of Look At Me In The Eyes!...ANGLE ANATOMY Put an iStent right here Internal Anatomy Lamina Cribrosa...
Look At Me In The Eyes!Anatomy of the Eye
Brent Deibert, MD
Finical Disclosures
None
External
Eyelid
Extraocular musclesWhy can these musclesnot be seen when lookingat the eye in clinic?
Cornea
Anterior Chamber Vs. Posterior Chamber
ANGLE ANATOMY
Put an iStentright here
Internal Anatomy
Lamina Cribrosa
Fundus Exam = Retina Exam
- Optic disc- Optic nerve- Papilla
Artery
Vein
Fovea
The Way Back of the Eye
Basic Blood Supply to Eye
Things Ophthalmologist do
Many Structures have different names and are used interchangeably
Most all of us Mumble and we talk directly only to the slit lamp
When you become an ophthalmologist your rate of speech increases
Ptosis Vs Dermatochalasis
Ptosis Vs Dermatochalasis
DermatochalasisExcess Skin over
Eyelids
PtosisDrooping eyelid
Entropion Vs Ectropion
Entropion Vs Ectropion
EntropionEyelids Directed Intowards the Eye
EctropionEyelids Directed Out
from Eye
Bonus: Arcus SenilusLipid deposition in the cornea
What is Injection of the Conjunctiva?
What is Injection of the Conjuctiva?
Most people call a red eye!
Increased blood flow toconjunctiva vessels
What is Conjunctivochalasis?
What is Conjunctivochalasis?
What is Chemosis?
What is Chemosis?
Serous Hemorrhagic
What is Sub Conj Heme?
Sub conjunctival Hemorrhage
Can take up to 4-6weeks to resolve
Hyphema vs Hypopion
Hyphema vs Hypopyon
HyphemaBlood in Anterior Chamber
HypopyonPus in Anterior Chamber
May be accompaniedby Cell and Flare
What is the Uvea?
What is the Uvea?(turns out it is a lot of things)
Uvea means grape = Does not help at all
Flame Hemorrhage Vs Dot Blot Hemorrhage
Flame Hemorrhage Vs Dot Blot Hemorrhage
Dot Blot Heme with VesselTortuosity
(Deeper in Retina)
Flame Heme(More Superficial in Retina)
What is a true cataract?
True Cataract
Common Types of Cataracts
Cortical Nuclear Posterior Subcapsular
Questions?
Herpes Zoster = ShinglesBrent Deibert, MD
Contributions from Helen Song MS4
What Causes Shingles?
Past infection with Varicella Zoster virus
Initial infection presentation is Chickenpox
More than 99% of adults age 50 years and older worldwide have been exposedto varicella zoster virus
Why do people get shingles?
After initial infection, the virus becomes dormant in the sensory ganglia
Waning immune system that occurs with aging (most common)
Immunocompromised state
HIV
Lymphoma/Leukemia
Medical Immunosuppression
Pregnancy
What do people with Shingles look like?
Dermatomal Rash, unilateral (usually)
Can be bilateral, Usually immunocompromised
Vesicular rash
PAINFUL! (pain control can require morphine)
What happens when it gets into the eye?(Herpes zoster ophthalmicus)
Pseudodendrite
Herpes Simplex Virus (HSV) Keratitis
Dendrite
Dermatomal Rash Does NOT accompany this!
Duration and Contagious Stage?
Blisters that typically scab (crusts) over in 7 to 10 days and fully clears upwithin 2 to 4 weeks.
Once the rash crusts, you are no longer infectious.
Can spread from a person with active shingles and cause chickenpox insomeone who had never had chickenpox or received chickenpox vaccine.
No Contact with Babies or Pregnant Woman!
Risk of spreading the virus is low if you cover the shingles rash
How do you treat Herpes ZosterOphthalmicus? (HEDS Trial)
To Hospital or Not to Hospital?
Immunocompetent Patients
Oral medications
Outpatient treatment
Some still get inpatient treatment for pain
Most will NOT require suppressive Anti-viral medications
Immunocompromised Patients
Intravenous Anti-Viral Medications
Admission to hospital
Will most likely receive suppression dosing of Anti-viral medications
What are the long-term effects of thiscondition?
Postherpetic Neuralgia
10 to 18% of those who get shingles
Older adult with shingles is more likely to develop PHN and have longer lasting andmore severe pain than a younger person with shingles
People younger than 40 rarely experience PHN
Vaccination!
Two shingles vaccines are licensed and recommended in the United States.
Zoster Vaccine Live (ZVL, Zostavax) (2006)
50% effective
Cheap
Recombinant Zoster Vaccine (RZV, Shingrix) (2017)
80% effective
$300 per injection
Two shot series over 6 months (Must get both for complete protection)
preferred shingles vaccine.
Who Should get the Vaccination? CDC Recommendation
Two doses of Shingrix
Separated by 2 to 6 months for immunocompetent adults age 50 years and older
Safe for immunocompromised since there is not live virus in the vaccine
If someone has shingles should they getthe shingrix vaccine?
Yes!
Helps decrease the likelihood of a second occurrence
With or without a report of prior episode of herpes zoster
Whether or not they have had Zostavax
Sources used for this lovely presentation
CDC.gov
HEDS Trial
Reichelt M, Zerboni L, Arvin AM. Mechanisms of varicella-zoster virusneuropathogenesis in human dorsal root ganglia. J Virol. 2008;82(8):3971–3983. doi:10.1128/JVI.02592-07
Questions?
No Ophthalmologists were harmed in themaking of this presentation.
